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Prognostic factors of surgical treatment of chronic thromboembolic pulmonary hypertension
Nižnanský, Matúš ; Lindner, Jaroslav (advisor) ; Rohn, Vilém (referee) ; Pudil, Radek (referee)
Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by increased pulmonary artery pressure. It is caused by intraluminal thrombi organisation, stenoses and occlusions of pulmonary artery and its branches and peripheral vascular remodeling. It is a chronic complication of acute pulmonary embolism. The obstruction of pulmonary artery branches increases pulmonary vascular resistance (PVR) and this leads to the right ventricular overload and right-sided heart failure. The treatment of choice is surgical pulmonary endarterectomy (PEA), a procedure that is performed in deep hypothermic cardiac arrest. Patients with peripheral type of CTEPH, who are not indicated for operation and also patients with residual pulmonary hypertension after PEA can be indicated for specific vasodilatation therapy. In indicated cases the treatment may involve the balloon pulmonary angioplasty or lung transplantation. Despite the high effectivity of PEA, there is a number of patients, whose pulmonary arterial pressure remains high and this plays a key role in postoperative mortality and morbidity. Incidence of residual pulmonary hypertension is according to literature between 16 and 51%. This leads to a pursuit of finding possible tools to predict residual pulmonary hypertension after PEA. The aim of...
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Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery
Mlejnský, František ; Lindner, Jaroslav (advisor) ; Lonský, Vladimír (referee) ; Vaněk, Tomáš (referee)
Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery Abstract Currently, the most commonly used technical solution for pumping blood during extracorporeal circulation during cardiac surgery, as well as for some types of ECMO (extracorporeal membrane oxygenation) are either a roller pump or centrifugal pump. Due to its advantages the centrifugal pump is mainly used for prolonged extracorporeal circulation in cardiac surgery and as a heart and / or lung support system. In current literature there is a lack of compelling scientific evidence that would clearly support its use in a routine cardiac surgery. The aim of our study was to compare both types of currently used blood pumps in longer cardiac procedures with deep hypothermic circulation arrest. In a randomized clinical study we had selected a group of patients that underwent a pulmonary endarterectomy (PEA) in order to demonstrate the positive effects of the centrifugal pump on the postoperative inflammatory reactions. There were no statistically significant differences between these two pumps when other clinical and laboratory parameters were observed. Based on the hypothesis that significant temperature changes during cardiac procedure with a deep hypothermia can affect sealing pressure of the endotracheal tube cuff, we performed a...
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Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery
Mlejnský, František ; Lindner, Jaroslav (advisor) ; Lonský, Vladimír (referee) ; Vaněk, Tomáš (referee)
Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery Abstract Currently, the most commonly used technical solution for pumping blood during extracorporeal circulation during cardiac surgery, as well as for some types of ECMO (extracorporeal membrane oxygenation) are either a roller pump or centrifugal pump. Due to its advantages the centrifugal pump is mainly used for prolonged extracorporeal circulation in cardiac surgery and as a heart and / or lung support system. In current literature there is a lack of compelling scientific evidence that would clearly support its use in a routine cardiac surgery. The aim of our study was to compare both types of currently used blood pumps in longer cardiac procedures with deep hypothermic circulation arrest. In a randomized clinical study we had selected a group of patients that underwent a pulmonary endarterectomy (PEA) in order to demonstrate the positive effects of the centrifugal pump on the postoperative inflammatory reactions. There were no statistically significant differences between these two pumps when other clinical and laboratory parameters were observed. Based on the hypothesis that significant temperature changes during cardiac procedure with a deep hypothermia can affect sealing pressure of the endotracheal tube cuff, we performed a...
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